News Article | May 22, 2017
Montreal, May 22, 2017 - In Canada, one in four women delivers by caesarean section. This procedure can save the life of the mother and baby. But the steady increase in the rate of caesareans in industrialized countries is cause for concern because a medically unnecessary caesarean entails the risk of additional complications for the mother and her child, as well as costs for the health system. For the first time, a study published today in BMC Medicine evaluated the economic impact and benefits of a training program developed jointly with the Society of Obstetricians and Gynaecologists of Canada (SOGC). "We have shown that professional training to reinforce skills in obstetric clinical practice and self-assessment are effective in reducing the rate of medically unnecessary caesareans and in improving the quality of care offered to mothers and babies. This training program resulted in a cost reduction of approximately $180 per birth. If a similar program were offered in all Quebec hospitals, it would amount to a savings of $15.8 million annually," declared Mira Johri, Principal Scientist at the University of Montreal Hospital Research Centre (CRCHUM), Professor at the university's School of Public Health and the lead author of the study. The QUARISMA (QUAlity of Care, Obstetrics RISk MAnagement and Mode of Delivery in Quebec) study is a cluster-randomized clinical trial that took place in 32 hospitals in Quebec between 2008 and 2012. In half of the hospitals targeted, the health professionals were trained to follow the QUARISMA program, which is based on training in clinical best practices and self-assessment through audit and feedback. The remaining hospitals -- the control group -- received standard care, with no special intervention. "We observed that a multifaceted audit and feedback intervention aimed at health professionals results in a slight reduction in the rate of caesareans for low-risk pregnancies, without adverse effects on maternal and neonatal health," revealed Nils Chaillet, principal investigator of the QUARISMA trial, researcher at the CHU de Québec-Université Laval Research Centre and professor at Université Laval's Faculty of Medicine. These results showing the program's effectiveness were published in The New England Journal of Medicine in April 2015. Today, after analyzing the effect of the program on 105,351 women included in the study, the researchers conclude that, in addition to reducing the number of medically unjustified caesareans, the program has made it possible to save money. How can a slight reduction in the rate of caesareans generate several millions of dollars in savings per year? Does this mean that caesareans are expensive interventions? "The main source of cost savings was not the modest reduction in the number of caesareans," explained Johri. "We discovered that better case management by clinicians led to fewer neonatal complications, and therefore better use of resources by the intervention group." The $15.8 million in savings can therefore be attributed mainly to optimizing the use of health interventions. "Caesareans are important for the reduction of perinatal mortality and morbidity in cases of high-risk pregnancies," added Chaillet. "However, medically unnecessary caesareans do not provide any benefits and can even lead to unnecessary complications." "When the time comes to decide whether to perform a caesarean or not, clinical factors do not always prevail," Johri concluded. "Improving health care quality is in everyone's interest. We have shown that a training program for health professionals reduces the number of medically unnecessary caesareans and benefits public finances and the health of mothers and babies." The article "A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis" was published on May 22, 2017 in BMC Medicine. This research project was funded by the Canadian Institutes of Health Research. Mira Johri is a researcher at the University of Montreal Hospital Research Centre and a professor at the university's School of Public Health. Nils Chaillet is a physician and researcher at the CHU de Québec-Université Laval Research Centre and a professor at Université Laval's Faculty of Medicine. For additional information, we invite you to read the study: https:/
News Article | April 4, 2017
It is an irrefutable fact that with the progression of age, the female body's ability to bear a child decreases. It has been a mystery why this may be the case — until now. A new study may finally be able to provide an answer to this question. A group of scientists from the University of Montreal Hospital Research Center conducted extensive research, which offers clues about female infertility. The study was conducted on older mice. Using state-of-the-art microscopic technology, researchers were able to determine a specific defect in the eggs belonging to the creatures. Scientists believe that this same defect may be present in the eggs of older human females, which causes complications while conceiving. Scientists carried out micromanipulations on mice eggs. The mice whose eggs were tested were aged 6 and 12 weeks, which is considered to be young for the creatures. The same procedure was followed for the eggs of 60-week mice, which is considered old. Researchers swapped the nuclei of the young eggs and placed them in the older eggs. They then observed the complications that arose following this change, which aimed to determine the cause of age-related infertility. The researchers found that the cell division process became distorted after the nuclei swap, which prohibited proper chromosome sharing to occur. This sharing is required for a pregnancy to initialize. "We found that the microtubules that orchestrate chromosome segregation during cell division behave abnormally in older eggs," stated professor Greg FitzHarris, a researcher at CRCHUM. He added that this abnormal movement of the microtubules is essentially what causes age-related infertility among females. "One of the main causes of female infertility is a defect in the eggs that causes them to have an abnormal number of chromosomes. These so-called aneuploid eggs become increasingly prevalent as a woman ages," explained FitzHarris. Previously, the scientific community believed that age-related infertility in women was caused by the improper working of the "glue" that kept chromosomes together. This theory is known as the "cohesion-loss" concept. However, the current research asserts that the study does not disprove the cohesion-loss theory. It only postulates that there could be another reason behind the phenomenon. The results of the latest study could pave the way for future treatments, which would perhaps address age-related infertility among women and aid in rejuvenating the eggs. However, researchers are quick to point out that such advancement would take several years as this study is just on a basic level. Many such similar studies would need to be conducted to learn more about these defects, before an effective treatment can be developed. The findings have been published in the journal Current Biology. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.
News Article | April 3, 2017
Infertility is recognized as a disease both in the U.S. and worldwide. It is clinically defined as the inability to get pregnant, or to successfully carry a pregnancy to term, after 1 year of unprotected sex. Approximately 1 in 8 U.S. couples are struggling to get pregnant or maintain a pregnancy. One third of infertility is typically attributed to men, another third to women, and a final third is thought to be caused by a combination of problems in both partners. Age is thought to play a crucial role in the ability to procreate. For a woman, the number of oocytes - that is, female egg cells before they fully develop into ova - naturally declines with age. Additionally, the quality of the eggs also decreases, particularly after a woman reaches the age of 37. New research, carried out by scientists at the University of Montreal Hospital Research Center (CRCHUM) in Canada, uses state-of-the-art microscopy technology in order to examine the genetics behind this aging process. The findings - published in the journal Current Biology - point to errors in chromosomal segregation as a new mechanism for explaining female age-related infertility. Eggs with an abnormal number of chromosomes are called aneuploid eggs, explain the researchers. As a woman ages, and particularly as she ages beyond 35 years, the number of aneuploid eggs increases. Until now, the widely accepted hypothesis for this increase in abnormal eggs stated that the glue-like substance - made of protein complexes called cohesins - that keeps the chromosomes unified starts to malfunction. This hypothesis has been called the "cohesion-loss" hypothesis. The new research does not contradict this theory, but it does find an additional problem. In the new study, the microtubules - which are small cylindrical structures within the cell that are responsible for cell movement and which organize themselves into a spindle - were found to be dysfunctional in older mice. Microtubules pull the chromosomes together around their spindle-like structure and "sort" them when it is time for the cells to divide. After cell division, microtubules send out these chromosomes to the opposite poles of the nucleus of the daughter cells in a process commonly known as chromosome segregation. In fact, Fitzharris says that "approximately 50 percent of the eggs of older females have a spindle with chaotic microtubule dynamics." The researchers learned this by micromanipulating the eggs of mice, a classic approach whereby the oocytes were swapped among young mice (aged between 6 and 12 weeks) and old ones (aged 60 weeks). "We swapped the nuclei of the young eggs with those of the old eggs and we observed problems in the old eggs containing a young nucleus," explains Shoma Nakagawa, a postdoctoral research fellow at CRCHUM and the Université de Montréal. "This shows that maternal age influences the alignment of microtubules independently of the age of the chromosomes contained in the nuclei of each egg." The findings also hold for humans, the authors explain. Chromosomal defects due to spindle malfunctioning occur in women as well, so age-related infertility does not seem to be caused by the age of the chromosomes themselves. In the future, the authors hope that their findings will help women to become pregnant despite their older age. "We are currently exploring possible treatments for eggs that might one day make it possible to reverse this problem and rejuvenate the eggs," says Fitzharris.
News Article | March 20, 2017
Have you been advised by your doctor to take medicines for high blood pressure? Think twice. Do you really think you have high blood pressure? A new study states that about 20 percent of people who get treated for hypertension don't actually have the problem and need not resort to any medication. Blood pressure or BP is often described as the pressure that the blood exerts on the artery walls. It is measured from arm artery and expressed in two numbers, which are the systolic BP and the diastolic BP. When systolic pressure is lower than 140 mmHg and the diastolic pressure is less than 90 mmHg, the BP is considered normal. If a person's BP figure crosses the above stated numbers, then it is said the individual has high BP. According to Centers for Disease Control and Prevention (CDC), there are about 75 million American adults who suffer from high BP, which is one of every three adults. Treatment for this problem nearly costs the nation around $46 billion each year. A study conducted by researchers from University of Montreal Hospital Research Centre (CRCHUM) claims that over half the family doctors present in Canada continue to use manual devices to measure BP. The usage of this dated technology often leads to misdiagnosis of the numbers. "Clinicians should use automatic devices. They are more expensive but more precise because they take several measurements. Manual measurement is acceptable if it's properly done, but that's often not the case," said Janusz Kaczorowski, the lead author of the study. The automated device eliminates the chance of what is known as the white-coat syndrome. This syndrome refers to the additional stress or artificial BP the patient faces for being in a clinical environment. Due to this elimination, Kaczorowski believes that the right BP measurement could be taken. The study conducted by Kaczorowski and team was a web-based, cross-sectional survey. It was performed by researchers and professors with the aim of finding out techniques family physicians in Canada currently deploy to gauge BP. Participants were chosen through stratified random sampling of family physicians in Canada. The survey was distributed to them via e-mail. It was seen that out of the 769 respondents of the survey, 54.2 percent stated that they use manually run devices to measure BP. Only 43 percent of the total participants admitted using an automated device for gauging BP. The study surmised that in Canada, from an overall perspective, there are a high number of family physicians using electronic devices for BP measurement. This study has been published in the Canadian Family Physician. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.
News Article | May 29, 2017
An experimental treatment in mice allows the reprogramming of blood cells in order to promote the healing process of cutaneous wounds. This approach could prove to be beneficial in healing challenging wounds in diabetics and major-burn victims. Montreal, May 29, 2017 - Diabetic patients frequently have lesions on their feet that are very difficult to heal due to poor blood circulation. In cases of serious non-healing infections, a decision to amputate could be made. A new therapeutic approach, presented recently in the Journal of Investigative Dermatology by Canadian researchers affiliated with the University of Montreal Hospital Research Centre (CRCHUM), could prevent these complications by promoting wound healing. The solution isn't what you might expect, not just another antibiotic ointment or other prescription medication. It's the approach that's different, a way to heal through personalized medicine. "We discovered a way to modify specific white blood cells - the macrophages - and make them capable of accelerating cutaneous healing," explained nephrologist Jean-François Cailhier, a CRCHUM researcher and professor at the University of Montreal. It has long been known that macrophages play a key role in the normal wound healing process. These white cells specialize in major cellular clean-up processes and are essential for tissue repair; they accelerate healing while maintaining a balance between inflammatory and anti-inflammatory reactions (pro-reparation). "When a wound doesn't heal, it might be secondary to enhanced inflammation and not enough anti-inflammatory activity," explained Cailhier. "We discovered that macrophage behaviour can be controlled so as to tip the balance toward cell repair by means of a special protein called Milk Fat Globule Epidermal Growth Factor-8, or MFG-E8." Cailhier's team first showed that when there is a skin lesion, MFG-E8 calls for an anti-inflammatory and pro-reparatory reaction in the macrophages. Without this protein, the lesions heal much more slowly. Then the researchers developed a treatment by adoptive cell transfer in order to amplify the healing process. Adoptive cell transfer consists in treating the patient using his or her own cells, which are harvested, treated, then re-injected in order to exert their action on an organ. This immunotherapeutic strategy is usually used to treat various types of cancer. This is the first time it has been shown to also be useful in reprogramming cells to facilitate healing of the skin. "We used stem cells derived from murine bone marrow to obtain macrophages, which we treated ex vivo with the MFG-E8 protein before re-injecting them into the mice, and we quickly noticed an acceleration of healing," said Dr. Patrick Laplante, Cailhier's research assistant and first author of the study. Added Dr. Cailhier, "the MFG-E8 protein, by acting directly upon macrophages, can generate cells that will orchestrate accelerated cutaneous healing." The beauty of this therapy is that the patient (in this case the mouse) is not exposed to the protein itself. Indeed, as Dr. Cailhier explained, "if we were to inject the MFG-E8 protein directly into the body there could be effects, distant from the wound, upon all the cells that are sensitive to MFG-E8, which could lead to excess repair of the skin causing aberrant scars named keloids. The major advantage [of this treatment] is that we only administer reprogrammed cells, and we find that they are capable of creating the environment needed to accelerate scar formation. We have indeed discovered the unbelievable potential of the macrophage to make healing possible by simple ex vivo treatment." What now remains to be done is to test this personalized treatment using human cells. Thereafter, the goal will be to develop a program of human cell therapy for diabetic patients and for victims of severe burns. It will take several years of research before this stage can be reached. This advanced personalized treatment could also make all the difference in treating cases of challenging wounds. According to the World Health Organization, diabetes affects 8.5% of the global population, and amputation rates of the lower extremities are 10 to 20 times higher in diabetics. "If, with this treatment, we can succeed in closing wounds and promoting healing of diabetic ulcers, we might be able to avoid amputations," Dr. Cailhier said. "Serious burn victims could also benefit," he added. "By accelerating and streamlining the healing of burns, we may be able to reduce the infections and keloids that unfortunately develop much too often in such patients." Cancer patients requiring extensive reconstruction surgery could also benefit, he said. The study "MFG-E8 reprogramming of macrophages promotes wound healing by increased bFGF production and fibroblast functions" was published on May 16 in the Journal of Investigative Dermatology. Jean-François Cailhier, a nephrologist and researcher at the University of Montreal Hospital Research Centre (CRCHUM), holds the Claude Bertrand Chair in Neurosurgery of the University of Montreal, and is a professor at the University of Montreal and member of the Institut du cancer de Montréal. The other authors are: Patrick Laplante, Frédéric Brillant-Marquis, Marie-Joëlle Brissette, Benjamin Joannette-Pilon, Romain Cayrol and Victor Kofta. This study was funded by the Institut du cancer de Montréal (ICM). For additional information, we invite you to read the study: DOI: http://dx.
News Article | May 29, 2017
Diabetic patients frequently have lesions on their feet that are very difficult to heal due to poor blood circulation. In cases of serious non-healing infections, a decision to amputate could be made. A new therapeutic approach, presented recently in the Journal of Investigative Dermatology by Canadian researchers affiliated with the University of Montreal Hospital Research Centre (CRCHUM), could prevent these complications by promoting wound healing. The solution isn't what you might expect, not just another antibiotic ointment or other prescription medication. It's the approach that's different, a way to heal through personalized medicine. "We discovered a way to modify specific white blood cells -- the macrophages -- and make them capable of accelerating cutaneous healing," explained nephrologist Jean-François Cailhier, a CRCHUM researcher and professor at the University of Montreal. It has long been known that macrophages play a key role in the normal wound healing process. These white cells specialize in major cellular clean-up processes and are essential for tissue repair; they accelerate healing while maintaining a balance between inflammatory and anti-inflammatory reactions (pro-reparation). "When a wound doesn't heal, it might be secondary to enhanced inflammation and not enough anti-inflammatory activity," explained Cailhier. "We discovered that macrophage behaviour can be controlled so as to tip the balance toward cell repair by means of a special protein called Milk Fat Globule Epidermal Growth Factor-8, or MFG-E8." Cailhier's team first showed that when there is a skin lesion, MFG-E8 calls for an anti-inflammatory and pro-reparatory reaction in the macrophages. Without this protein, the lesions heal much more slowly. Then the researchers developed a treatment by adoptive cell transfer in order to amplify the healing process. Adoptive cell transfer consists in treating the patient using his or her own cells, which are harvested, treated, then re-injected in order to exert their action on an organ. This immunotherapeutic strategy is usually used to treat various types of cancer. This is the first time it has been shown to also be useful in reprogramming cells to facilitate healing of the skin. "We used stem cells derived from murine bone marrow to obtain macrophages, which we treated ex vivo with the MFG-E8 protein before re-injecting them into the mice, and we quickly noticed an acceleration of healing," said Dr. Patrick Laplante, Cailhier's research assistant and first author of the study. Added Dr. Cailhier, "the MFG-E8 protein, by acting directly upon macrophages, can generate cells that will orchestrate accelerated cutaneous healing." The beauty of this therapy is that the patient (in this case the mouse) is not exposed to the protein itself. Indeed, as Dr. Cailhier explained, "if we were to inject the MFG-E8 protein directly into the body there could be effects, distant from the wound, upon all the cells that are sensitive to MFG-E8, which could lead to excess repair of the skin causing aberrant scars named keloids. The major advantage [of this treatment] is that we only administer reprogrammed cells, and we find that they are capable of creating the environment needed to accelerate scar formation. We have indeed discovered the unbelievable potential of the macrophage to make healing possible by simple ex vivo treatment." What now remains to be done is to test this personalized treatment using human cells. Thereafter, the goal will be to develop a program of human cell therapy for diabetic patients and for victims of severe burns. It will take several years of research before this stage can be reached. This advanced personalized treatment could also make all the difference in treating cases of challenging wounds. According to the World Health Organization, diabetes affects 8.5% of the global population, and amputation rates of the lower extremities are 10 to 20 times higher in diabetics. "If, with this treatment, we can succeed in closing wounds and promoting healing of diabetic ulcers, we might be able to avoid amputations," Dr. Cailhier said. "Serious burn victims could also benefit," he added. "By accelerating and streamlining the healing of burns, we may be able to reduce the infections and keloids that unfortunately develop much too often in such patients." Cancer patients requiring extensive reconstruction surgery could also benefit, he said.
News Article | May 9, 2017
People who use commonly prescribed non-steroidal anti-inflammatory drugs (NSAIDs) to treat pain and inflammation could be raising their risk of having a heart attack, as early as in the first week of use and especially within the first month of taking high doses of such medication, suggests a study in The BMJ this week. Doctors and patients urged to weigh the risks and benefits of ibuprofen, diclofenac, celecoxib, and naproxen Previous studies suggested that both traditional and COX 2 selective NSAIDs could increase the risk of acute myocardial infarction (heart attack), but the timing of the risk, the effect of dose, treatment duration, and the comparative risks between NSAIDs were poorly understood. An international team of researchers led by Michèle Bally of the University of Montreal Hospital Research Center (CRCHUM), then an epidemiology doctoral student at McGill University in Canada, set out to characterise the risks of heart attack associated with use of oral NSAIDs under real life practice circumstances. For their study, the researchers carried out a systematic review and a meta-analysis of relevant studies from various healthcare databases including those from Canada, Finland and the United Kingdom. Collectively, they analysed results on 446,763 people of whom 61,460 had a heart attack. The NSAIDs of interest to the researchers were celecoxib, the three main traditional NSAIDs (diclofenac, ibuprofen, and naproxen), and rofecoxib. To provide guidance, the researchers presented their results as probabilities of having a heart attack. They looked at various scenarios corresponding to how people might routinely use these drugs. The study found that taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of heart attack. Naproxen was associated with the same risk of heart attack as that documented for other NSAIDs. With celecoxib, the risk was lower than for rofecoxib (Vioxx) and was comparable to that of traditional NSAIDs. Overall the increase in risk of a heart attack is about 20 to 50% if using NSAIDs compared with not using these medications. To put this in perspective, as a result of this increase, the risk of heart attack due to NSAIDs is on average about 1% annually. The type of analysis the researchers used allowed them to conclude with greater than 90% probability that all NSAIDs studied are associated with a heightened risk of heart attack. Further analysis suggested that the risk of heart attack associated with NSAID use was greatest with higher doses and during the first month of use. With longer treatment duration, risk did not seem to continue to increase but the researchers caution that they did not study repeat heart attacks such that it remains prudent to use NSAIDs for as short time as possible. This is an observational study based on drug prescribing or dispensing and not all potentially influential factors could be taken into account. Although this means that conclusions cannot be made about cause and effect, the authors say that their study was the largest investigation of its type and that its real-world origin helped to ensure that findings were broadly generalisable. The researchers also emphasise the advantages of sharing 'de-identifed' patient data as this helps making healthcare decisions that may improve patient care. They conclude: "Given that the onset of risk of acute myocardial infarction occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses."
News Article | April 14, 2016
Catherine Aaron and Gabrielle Beaudry were 17 when they knocked on the door of the laboratory of Alex Parker, a neuroscience researcher at the University of Montreal Hospital Research Centre (CRCHUM). While students at Collège Jean-de-Brébeuf in Montreal, they were looking for a mentor for an after-school research project. Two and half years later, the results of this scientific adventure were published today in the Journal of Agricultural and Food Chemistry. "We wanted to test the effect of a natural product on a neurodegenerative disease such as Alzheimer's. Professor Parker had already discovered that sugar prevents the occurrence of amyotrophic lateral sclerosis (ALS) in an animal model of the disease, the C. elegans worm. That's how we got the idea of maple syrup, a natural sugar produced in Quebec," said Beaudry. Supervised by Ph.D. student Martine Therrien and Alex Parker, Aaron and Beaudry added maple syrup to the diet of these barely 1 mm-long nematodes. "We just gave them a supplement of maple syrup at various concentrations and compared with a control group that had a normal diet," said Aaron. "After twelve days, we counted under the microscope the worms that were moving and those that were paralyzed. The worms that had consumed the highest dose of syrup were much less likely to be paralyzed." Alex Parker's C. elegans worms are genetically modified to express a protein involved in ALS in motor neurons - TDP-43. "When they are adults, around 12 days, their motor neurons break down. Normally, at two weeks of life, 50 percent of the worms are completely paralyzed. But among those that received a diet enriched with 4 percent maple syrup, only 17 percent were paralyzed. We can therefore conclude that maple syrup protects neurons and prevents the development of amyotrophic lateral sclerosis in C. elegans worms," said Parker, a researcher at the CRCHUM and professor at the Faculty of Medicine, University of Montreal. How can we explain this dramatic effect? "Sugar is good for the nervous system. Diseased neurons require more energy to combat toxic proteins. But maple syrup is rich in polyphenols, powerful antioxidants found in certain foods. We isolated phenols contained in the maple syrup, and we showed that two polyphenols in particular, gallic acid and catechol, have a neuroprotective effect. In pure maple syrup, these polyphenols are found in low concentrations. Probably a combination of sugar and polyphenols prevents the occurrence of the disease in worms," said Therrien, a Ph.D. student at the CRCHUM. But don't go ahead and gorge yourself on maple syrup thinking it'll protect you against neurological diseases! "The life expectancy of C. elegans worms is only three weeks. They are spared the long-term toxic effects of sugar. Humans who consume comparable amounts of sugar risk developing chronic diseases such Type 2 diabetes and obesity," cautioned Parker. Amyotrophic lateral sclerosis is a rare neuromuscular disease that causes paralysis and death a few years after the onset of symptoms. So far, no cure is available for patients. This latest study on maple syrup and the C. elegans worm was conducted for educational purposes. Other studies by Alex Parker with C. elegans have led to the discovery of promising drugs, which will be tested in patients in a few years. Catherine Aaron and Gabrielle Beaudry won the Sanofi Biogenius Canada People's Choice Award - Quebec section - for this project in April 2014. Aaron is now a first-year medical student at the University of Montreal, and Beaudry studies psychology at the University of Sherbrooke.
News Article | February 27, 2017
It is 2012 and Smiley, a young woman in her early 20s, lives in a single room occupancy (SRO) building in Vancouver. She wants to hang out with her friends in her room, where she feels safe, but the SRO only allows one visitor at a time. "I don't like it. It's their rules. It's really annoying," Smiley said. "It sucks, because I'm not a crackhead or a junkie. They shouldn't put me in places like that." Smiley has been diagnosed with psychosis, a mental disorder where people show signs of delusions and hallucinations. She's one of 17 young people between the ages of 18 to 24 in Metro Vancouver recruited for a study at the University of British Columbia. All participants have experienced symptoms of psychosis in the past three years. "Our study provides a window into what young people think about the mental health services they receive and what they feel helps and hinders their well-being," said lead author Shalini Lal, an assistant professor at the University of Montreal's school of rehabilitation and a researcher at the University of Montreal's Hospital Research Centre (CRCHUM). Lal conducted the study as part of her PhD work at UBC's faculty of medicine within the graduate programs of rehabilitation sciences. Through interview excerpts with the youth from November 2010 to March 2012, the study highlights the impacts of mental health services on these young people, including their interactions with psychiatrists, case managers, social workers and supports for housing, recreation, and employment. "Eliciting young people's feedback will lead to better planning and coordination of services that they will find engaging, meaningful and effective," said Lal. The study identifies many different types of supports the youth found helpful, including group therapy and positive interactions with peers and peer support workers. "The groups were very helpful for getting me to acknowledge that I actually had an illness," said Kevin, one of the youth. "(The peer support worker) explained that with the right combination of medications or professional help, you could actually treat the symptoms and live a normal life... a good role model to see that you could recover from it," said Jake, another youth involved in the study. Other types of support the youth identified as helpful were accompaniment to appointments, providing help in completing employment assistance forms and facilitating the process of returning to school. Youth also appreciated emotional support like signs of genuine kindness, hope and encouragement from service providers. "Even small gestures were seen as helpful, ones we may take for granted, like a care manager shaking their hand when they walked in the door," said Lal. "That gesture of respect has a lot of meaning for someone stigmatized by mental illness." When it came to hindrances, some youth felt pigeonholed by their mental illness, being offered services that didn't reflect an identity outside their disorder. A young man named Nelson, who had acting aspirations, told Lal about his disappointment when his job counselor connected him to a theatre company dedicated to "people affected by mental illness." "The most annoying thing is that everything is for mental health reasons and I just don't want this," he said. "If it's a film thing, I don't want it to be just for mentally ill, and just to address stuff like that. I want it to be, just normal." Darren, a 20-year-old living in a downtown youth shelter, didn't own a cellphone and could not receive calls directly from the shelter. His sense of independence and social life were negatively impacted by the shelter's rules of no Facebook access, which was his main way of staying in touch with friends and family. Lal said in some cases the youth also interacted with outreach workers online, which proved useful to providing support to people who would not otherwise receive it any other way. Some youth felt "ghettoized" by their housing situation, only being able to access SROs that housed many others living with mental health and substance abuse issues. Philip, a young man struggling with substance abuse in addition to his psychosis, said living in such an environment threatened his sobriety. "Every time you walk down the street you see someone on a crack pipe, a crystal meth pipe, a pot pipe or drinking alcohol every block you walk here," he said. "And it's nothing but trigger after trigger here, so it's not the right environment for people trying to stay sober. Just being around these kinds of people, it's not the right place for me." The last hindrance was how impersonal the youth felt some of their encounters could be with different support workers, including doctors or therapists. "It was always kind of detached, and I always felt like we were on the clock and not really supported to talk about things like that [relationships]... It just wasn't an environment where I felt comfortable with it," said Kevin. Lal said she has seen more funding and attention being paid to the mental health needs of young people in Canada, especially over the past five years. Lal also said more effort is needed in using tools and resources that cater to youth, including the use of technology to provide support. As well, different sectors of the community, including housing, employment and mental health, need to work more closely together, so people don't feel bounced around. "People often think that it's up to individuals alone to overcome adversity, to deal with a mental illness," Lal said. "For young people, their resiliency largely depends on their ability to navigate and negotiate towards resources, which are all too often substandard, inconsistent or not tailored to their needs." "We learned from this study that when services do match young people's needs and preferences, they can really make a positive impact on their well-being." The study, Impact of Mental Health Services on Resilience in Youth with First Episode Psychosis: A Qualitative Study, was published in print this year in Administration and Policy in Mental Health and Mental Health Services Research. Lal's co-authors are Michael Ungar at Dalhousie University, Ashok Malla at McGill University and Carl Leggo and Melinda Suto at UBC. The 17 youth involved in the study had an average age of 22 and 71 per cent were male. The youth were white, First Nations, Asian and Latin American. Seven of the youth had less than a high school education, five had completed high school, four had some university-level education, and one had completed a bachelor's degree. Names in this study were changed to protect the youths' identities and were chosen by the youth themselves. They are not available for interviews.
News Article | October 29, 2016
You've tried all the diets. No matter: you've still regained the weight you lost, even though you ate well and you exercised regularly! This may be due to a particular enzyme in the brain: the alpha/beta hydrolase domain-6 enzyme, better known as ABHD6. A study published this week in Cell Reports demonstrates that when this enzyme is blocked in certain neurons of the mouse hypothalamus, it becomes impossible for them to lose weight, even if they adhere to an ideal regimen… ideal for mice that is! A research team at the University of Montreal Hospital Research Centre (CRCHUM) has generated genetically engineered mice, deprived of the ABHD6 enzyme in a localized area of the brain, namely in a specific population of hypothalamic neurons. Alexandre Fisette, postdoctoral researcher at CRCHUM and first author of the study, explains that, "under normal conditions of housing and food, these mice are identical to normal mice. However, when challenged, they are unable to adapt. They no longer consume food after a fast, they cannot maintain their body temperature during exposure to cold, and they are more susceptible to become obese when fed a high-fat diet. What's more, once they are obese and we try to make them lose weight by feeding them a normal diet, they do not lose weight." The researchers have discovered that this enzyme acts as a sort of switch for the body's adjustment to extremes. "It is a mechanism we had not suspected. Strikingly, the absence of one single enzyme within a precise region of the brain completely disrupts the normal metabolism and prevents the mice from losing weight," comments Thierry Alquier, CRCHUM researcher and professor at the University de Montréal. Is there an identical process taking place in humans? Thierry Alquier thinks that clinical studies will be required to find out. However, according to Alquier, "ABHD6 has a key role in the rebound effect that is often observed after a dietary regimen. People who experience difficulty losing weight might have a deficiency of this enzyme." Weight is controlled by several signals. Scientists have known for a long time that endocannabinoids -- molecules secreted by the brain -- are involved in the ingestion of nutrients and the expenditure of energy. The endocannabinoids stimulate appetite. Thus, this is an interesting area of exploration in the search for an appetite-suppressant drug. But all the products developed until now have been associated with serious side effects. The pursuit of the ABHD6 enzyme appears to be promising. In 2014, the team of Marc Prentki, another CRCHUM researcher, discovered that this enzyme breaks down endocannabinoids. Blocking ABHD6 in peripheral organs and adipose tissues protects against obesity and against type 2 diabetes. "We know today that ABHD6 plays a completely different role in certain neurons of the hypothalamus. Blocking the enzyme in this location promotes obesity, whereas blocking it elsewhere in the body has beneficial effects," emphasizes Stephanie Fulton, CRCHUM researcher and study co-author. Multiple signals and neuronal networks are involved in regulating the balance of energy so as to maintain a stable body weight. "We have shown the critical part played by the ABHD6 enzyme in preserving homeostasis in specific neurons of the hypothalamus. But we don't know what happens when we block the enzyme in the entire brain. This is what we are currently investigating in an ongoing study," the researcher explains. Many more years of research will be needed to develop an effective treatment for obesity. As science advances, we learn that weight management does indeed take place inside the head, but that it is not necessarily a question of lack of will.